title: Visual system involvement in patients with Friedreich's ataxia.
abstract: Optic neuropathy is common in mitochondrial disorders, but poorly characterized in Friedreich's ataxia (FRDA), a recessive condition caused by lack of the mitochondrial protein frataxin. We investigated 26 molecularly confirmed FRDA patients by studying both anterior and posterior sections of the visual pathway using a new, integrated approach. This included visual field testing and optical coherence tomography (OCT), pattern visual evoked potentials (P-VEPs) and diffusion-weighted imaging. The latter was used to study optic radiation by calculating water apparent diffusion coefficients (ADC). All patients suffered optic nerve involvement with their disorder. Different patterns of visual field defects were observed and a variably reduced retinal nerve fiber layer thickness was seen by OCT in all cases. P-VEPs were abnormal in approximately half of the patients. Decreased visual acuity and temporal optic disc pallor were present in advanced stages of the disease, but only five patients were symptomatic. Two of these patients suffered a sudden loss of central vision, mimicking Leber's hereditary optic neuropathy (LHON), and of the other three symptomatic patients two were noted to be compound heterozygotes. ADC values of optic radiations in patients were significantly higher than controls (P < 0.01). Retinal nerve fiber layer thickness at OCT and P-VEPs correlated with age at onset and ICARS total score. ADC values correlated with age at onset, disease duration, GAA triplet expansion size, ICARS total score and P-VEPs. Visual pathway involvement is found consistently in FRDA, being previously underestimated, and we here document that it also involves the optic radiations. Occasional LHON-like cases may occur. However, optic neuropathy in FRDA substantially differs from classic mitochondrial optic neuropathies implying a different pathophysiology of visual system degeneration in this mitochondrial disease.
authors.affiliation: Dipartimento di Scienze Neurologiche, Università di Bologna, Bologna, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Fortuna
authors.forename: Piero
authors.initials: P
authors.lastname: Barboni
authors.forename: Rocco
authors.initials: R
authors.lastname: Liguori
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Valentino
authors.forename: Giacomo
authors.initials: G
authors.lastname: Savini
authors.forename: Cinzia
authors.initials: C
authors.lastname: Gellera
authors.forename: Caterina
authors.initials: C
authors.lastname: Mariotti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rizzo
authors.forename: Caterina
authors.initials: C
authors.lastname: Tonon
authors.forename: David
authors.initials: D
authors.lastname: Manners
authors.forename: Raffaele
authors.initials: R
authors.lastname: Lodi
authors.forename: Alfredo A
authors.initials: AA
authors.lastname: Sadun
authors.forename: Valerio
authors.initials: V
authors.lastname: Carelli
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001931:Brain Mapping / Q000379:methods; D005074:Evoked Potentials, Visual; D005260:Female; D005621:Friedreich Ataxia / Q000150:complications* / Q000235:genetics / Q000503:physiopathology; D006801:Humans; D033862:Iron-Binding Proteins / Q000235:genetics; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011930:Reaction Time; D012165:Retinal Ganglion Cells / Q000473:pathology; D012684:Sensory Thresholds; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity; D014794:Visual Fields; D014795:Visual Pathways / Q000503:physiopathology; D055815:Young Adult; D000096923:Frataxin
chemical_list: D033862:Iron-Binding Proteins; D000096923:Frataxin